Brannan v. Lankenau Hospital

• Citation: 417 A.2d 196,490 Pa. 588
• Parties: Stephen BRANNAN, Appellant, v. LANKENAU HOSPITAL, Hunter S. Neal, M.D., Eugene B. Rex, M.D., Clifton F. West, Jr., M.D.
• Decision Date: 15 August 1980
• Court: United States State Supreme Court of Pennsylvania

Page 196

417 A.2d 196

490 Pa. 588

Stephen BRANNAN, Appellant, v. LANKENAU HOSPITAL, Hunter S. Neal, M.D., Eugene B. Rex M.D., Clifton F. West, Jr., M.D.

Supreme Court of Pennsylvania.

Argued April 21, 1980.

Decided July 3, 1980.

Reargument Denied Aug. 15, 1980.

Joseph D. Shein, Philadelphia, for appellant.

Ralph L. Hose, A. Grant Sprecher, Philadelphia, John C. Bonner, Norristown, for appellees.

Before EAGEN, C. J., and O'BRIEN, ROBERTS, NIX, LARSEN, FLAHERTY and KAUFFMAN, JJ.

OPINION OF THE COURT

ROBERTS, Justice.

In this malpractice action, appellant Stephan Brannan seeks to recover from appellees, Lankenau Hospital and Drs. Eugene Rex and Clifton West, Jr. We are asked to review the trial court's removal from the jury's consideration questions of whether appellees Drs. Rex and West negligently treated appellant's infection and also whether appellee Lankenau Hospital is liable for its intensive care unit staff's failure properly to monitor appellant's condition. Review of this record discloses that appellant presented sufficient evidence to warrant submission of these issues to the jury. Accordingly, we reverse the order of the Superior Court, 254 Pa.Super. 352, 385 A.2d 1376, affirming the trial court's denial of appellant's motions to remove the nonsuits.

On Saturday evening, August 28, 1965, appellant attended a wedding reception at the William Penn Civic Club in Philadelphia. Soon after arriving at the club, he obtained a roast beef sandwich and a glass of beer. His first bite of the thickly sliced beef sandwich became lodged deep in his throat, blocking the throat passage. He immediately attempted to remove the obstruction, but was unsuccessful. Appellant left the reception and went home. There he drank fluids, but still he could not remove the blockage.

After a sleepless night, appellant went to the emergency room at Lankenau Hospital. There, appellee Dr. Rex, ordered x-rays, examined appellant, and recommended surgery for removal of the impacted piece of meat. Appellant initially refused surgery, preferring to await the natural passage of the beef. After Dr. Rex informed appellant that the procedure typically involved only an overnight hospital stay, appellant agreed to the operation.

At approximately 4:00 p. m. on August 29, Dr. Rex performed an esophagoscopy on appellant to relieve the blockage. During the surgical procedure, Dr. Rex removed several small portions of meat, eventually reducing the size of the portion to allow its passage into appellant's stomach. The surgery, however, was imperfect. Dr. Rex's operative notes reflect that a screw on the forward grasping forceps broke while inside appellant's esophagus. As a result, the forceps opened suddenly and its narrow, pointed ends touched the walls of the esophagus. Dr. Rex made a visual inspection of the esophageal wall in search of possible perforations. At that time, however, the doctor found no evidence of perforation.

Appellant was taken from the operating theatre and placed in the recovery room. Shortly after appellant awoke from the anesthesia, he suffered abdominal cramps. By 8:00 p. m., appellant's body temperature had increased to 100.4o . Hospital employees promptly notified Dr. Rex of this change in appellant's condition. Dr. Rex in turn requested that appellee Dr. West, an associate surgeon at Lankenau, examine appellant. Dr. Rex left the hospital without informing Dr. West that the forceps broke during the operation and possibly perforated the esophagus.

At about 11:00 p. m., Dr. West, reviewed appellant's x-rays, then telephoned Dr. Rex at home to discuss appellant's condition. Dr. West informed Dr. Rex that the x-ray did not clearly indicate a perforated esophagus. Dr. West ordered hospital employees to monitor appellant's vital signs and to transfer appellant to the main surgical floor intensive care unit of the hospital. Dr. West then left the hospital.

At 4:00 a. m. the next morning hospital personnel transferred appellant to the intensive care ward. Appellant's temperature then had risen to 100.6o or 100.8o . No additional temperature recordings were noted until several hours later that morning. At 8:00 a. m. Dr. West returned to the hospital and discovered that appellant's temperature had increased to 101.8o . Appellant's rate of respiration and pulse had also elevated. Despite appellant's removal to the intensive care unit, no hospital personnel monitored this change in appellant's condition. Nor did intensive care personnel notify Dr. West of these changed circumstances. At 8:00 a. m. Dr. West for the first time diagnosed appellant's condition as a perforated esophagus. By way of treatment, he then ordered the administration of antibiotics.

Appellant received the first dosage of antibiotics at 12:30 p. m., more than four hour after Dr. West's order. By that time infection had set in. As a result of the infection, appellant suffered a meningeal stroke, was forced to undergo several additional surgical procedures and lost the full use of his right arm and left leg. These disabilities kept appellant from continuing his previous employment.

Appellant initiated this malpractice action against Lankenau Hospital on August 28, 1967. ¹ Lankenau joined Drs. Rex, West and Hunter S. Neal as additional defendants. ² The parties engaged in extensive pre-trial discovery, and trial began on December 10, 1974. Appellant proceeded against Dr. Rex on the multiple theories of negligence, alleging that Dr. Rex (1) negligently punctured appellant's esophagus during surgery when the forceps he used broke, (2) failed to diagnose and treat appellant's punctured esophagus in a timely manner, (3) did not obtain appellant's "informed consent" to this surgical procedure, and (4) failed to inform Dr. West of the forcep problem. Against Dr. West, appellant proceeded on the theory of failure to administer antibiotics at an earlier time. Finally, appellant alleged that Lankenau Hospital, on a theory of respondeat superior, failed to provide adequate care during the time appellant remained in the intensive care unit. At the close of appellant's case, the Court of Common Pleas of Montgomery County granted involuntary nonsuits in favor of Lankenau, Dr. Neal and Dr. West. The court also refused to submit to the jury the issue of Dr. Rex's failure to administer antibiotics at an earlier time. The court did permit appellant's case against Dr. Rex to go to the jury on the other three issues: that the surgery was negligently performed, that Dr. Rex failed to notify Dr. West of the forcep problem, and that appellant had not "consented" to surgery.

The court justified the nonsuit in favor of Lankenau on the ground that appellant failed to introduce any expert testimony regarding hospital practice, and thus, the issue was not for the jury. As to the alleged negligence of Drs. West and Rex in failing to administer antibiotics, the court determined that appellant's expert witness (1) "gave contradictory statements with regard to defendants' negligence" and (2) made it clear that the doctors acted consistently with a respected body of medical thought.

After consideration of the limited issues presented, the jury returned a verdict in favor of Dr. Rex. Appellant filed motions for judgment n. o. v. and a new trial. Following argument, on the motions, the court en banc on April 8, 1976, denied appellant's post-trial motions. ³ On appellant's appeal, the Superior Court, (Van der Voort, J., dissenting in part), rejected appellant's contentions and affirmed the trial court order denying appellant relief. We granted allowance of appeal.

In passing on the trial court's refusal to grant appellant's motion to strike the nonsuits entered in favor of appellees, we must view "the evidence adduced on behalf of the plaintiff as true; reading it in the light most favorable to him; giving him the benefit of every reasonable inference that a jury might derive from the evidence and resolving all doubts, if any, in his favor." Auel v. White, 389 Pa. 208, 210, 132 A.2d 350, 352 (1957). Appellant's evidence, when reviewed in light of this standard, is sufficient to avoid the entry of a nonsuit in favor of Drs. Rex and West.

Appellant must satisfy the burden of proving that the act of the physicians or hospital fell below the standard of care owed him. Hamil v. Bashline, 481 Pa. 256, 392 A.2d 1280 (1978); Incollingo v. Ewing, 444 Pa. 263, 282 A.2d 206 (1971); Donaldson v. Mafucci, 397 Pa. 548, 156 A.2d 835 (1960). To satisfy his burden of proving Drs. Rex and West negligent in failing to administer antibiotics earlier, appellant must introduce expert testimony to show that appellee physicians' conduct varied from accepted medical practice. Chandler v. Cook, 438 Pa. 447, 265 A.2d 794 (1970); Dornon v. Johnston, 421 Pa. 58, 218 A.2d 808 (1966). This requirement stems from judicial concern that, absent the guidance of an expert, jurors are unable to determine relationships among scientific factual circumstances. McMahon v. Young, 442 Pa. 484, 276 A.2d 534 (1971); Florig v. Sears, Roebuck and Co., 388 Pa. 419, 130 A.2d 445 (1957).

We are satisfied that appellant offered competent testimony to establish that Drs. Rex and West failed to administer antibiotics at the earliest opportunity. On direct, appellant's expert Dr. Thompson testified that the recognized standard of care among physicians required the administration of antibiotics immediately upon suspicion of a perforated esophagus. Dr. Thompson stated that both Dr. Rex and Dr. West acted negligently in failing to administer the drugs at the earliest time perforation was suspected.

We cannot accept the Superior Court's view that Dr. Thompson sufficiently equivocated on his direct and re-direct testimony to justify the conclusion that a verdict based upon his testimony would be conjecture. Although after one day of direct testimony Dr. Thompson did indicate on re-direct the next day that he "can't answer" ...